Exploring targets and therapies for amyotrophic lateral sclerosis: current insights into dietary interventions

Shyuan T Ngo,1–5 Jia D Mi,1 Robert D Henderson,3,4 Pamela A McCombe,3,4 Frederik J Steyn3–5 1School of Biomedical Sciences, 2Queensland Brain Institute, 3Centre for Clinical Research, The University of Queensland, 4Department of Neurology, Royal Brisbane & Women’s Hospital, 5Wesley Medical Research, The Wesley Hospital, Auchenflower, Brisbane, QLD, Australia Abstract: A growing number of preclinical and human studies demonstrate a disease-modifying effect of nutritional state in amyotrophic lateral sclerosis (ALS). The management of optimal nutrition in ALS is complicated, as physiological, physical, and psychological effects of the disease need to be considered and addressed accordingly. In this regard, multidisciplinary care teams play an integral role in providing dietary guidance to ALS patients and their carers. However, with an increasing research focus on the use of dietary intervention strategies to manage disease symptoms and improve prognosis in ALS, many ALS patients are now seeking or are actively engaged in using complementary and alternative therapies that are dietary in nature. In this article, we review the aspects of appetite control, energy balance, and the physiological effects of ALS relative to their impact on overall nutrition. We then provide current insights into dietary interventions for ALS, considering the mechanisms of action of some of the ­common dietary interventions used in ALS, discussing their validity in the context of clinical trials. Keywords: ALS, treatment, alternative off-label therapies, antioxidants, clinical trials, nutrition